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Mujer de 32 años con clínica de neuralgia del trigémino en rama V1 y V2 izquierda. (A) La secuencia altamente potenciada en T2 de la RM muestra la existencia de un conflicto neurovascular entre el V par craneal y la arteria cerebelosa superior. La técnica realizada fue la propuesta por Jannetta consistente en la identificación del conflicto (B) y su resolución mediante la interposición de teflón (C). Además, durante la intervención quirúrgica se identificó una estructura venosa que improntaba ligeramente el nervio. Flecha: arteria cerebelosa superior. Flecha punteada: vena petrosa. 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The navy blue line indicates the proportion of OPEN procedures, while the crimson line represents the ENDO procedures." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Ignacio Arrese, Sergio García-García, Santiago Cepeda, Rosario Sarabia" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Ignacio" "apellidos" => "Arrese" ] 1 => array:2 [ "nombre" => "Sergio" "apellidos" => "García-García" ] 2 => array:2 [ "nombre" => "Santiago" "apellidos" => "Cepeda" ] 3 => array:2 [ "nombre" => "Rosario" "apellidos" => "Sarabia" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2529849624000352?idApp=UINPBA00004B" "url" => "/25298496/unassign/S2529849624000352/v1_202407110420/en/main.assets" ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "Clinical Research" "titulo" => "Review of therapeutic failures of microvascular decompression in trigeminal neuralgia at a tertiary hospital" "tieneTextoCompleto" => 0 "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Emilio González Martínez, Giancarlo Mattos-Piaggio, David Santamarta Gómez" "autores" => array:3 [ 0 => array:4 [ "nombre" => "Emilio González" "apellidos" => "Martínez" "email" => array:1 [ 0 => "egonzalezmart@saludcastillayleon.es" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "Giancarlo" "apellidos" => "Mattos-Piaggio" ] 2 => array:2 [ "nombre" => "David Santamarta" "apellidos" => "Gómez" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Neurocirugía, Hospital Universitario de León, León, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Revisión de los fracasos terapeúticos de la descompresión microvascular en la neuralgia del trigémino en un hospital terciario" ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2024-01-30" "fechaAceptado" => "2024-09-26" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1900056" "palabras" => array:5 [ 0 => "trigeminal neuralgia" 1 => "microvascular decompression" 2 => "neurovascular conflict" 3 => "outcome" 4 => "surgical treatment" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1900057" "palabras" => array:5 [ 0 => "Neuralgia del trigémino" 1 => "descompresión microvascular" 2 => "conflicto neurovascular" 3 => "pronóstico" 4 => "técnica quirúrgica" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "IntroductionMicrovascular decompression (MVD) is a non-ablative technique aimed at relieving pain in trigeminal neuralgia (TN) by resolving a neurovascular conflict. Despite reported high success rates, a significant percentage of patients experience therapeutic failure. MethodsRetrospective observational study of patients with suspected TN undergoing MVD was performed with the goal of identifying factors contributing to the persistence and recurrence of pain. ResultsIn the present study, 31 patients undergoing 38 MVD procedures for TN were included (7 patients underwent reoperation after the failure of the initial operation). The mean age was 58.5 years with a male predominance (58.1%). The mean duration of pain was 6.4 years, mainly affecting branches V2 and V3 (46.7%). The most frequently described neurovascular conflict was with the superior cerebellar artery (54.8%), predominantly resolved with Teflon (75.9%).In our case series, MVD achieved pain control in 80.6% of patients at one-year post-intervention and 61.3% at the end of the follow-up period. Twelve patients experienced MVD failure: 5 cases of persistent pain and 7 cases of pain recurrence. A detailed analysis of these failures identified misdiagnosis as the reason of persistent pain in 4 patients, while inadequate surgical technique could be the cause of pain recurrence in 6 patients. ConclusionIn our study, therapeutic failures could mainly be attributed to two factors: misdiagnosis or the use of inappropriate materials. These factors should be considered when optimizing the management of DMV in patients with NT." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "IntroducciónLa descompresión microvascular (DMV) es una técnica no ablativa dirigida a aliviar el dolor en la neuralgia del trigémino (NT) mediante la resolución del conflicto neurovascular. A pesar de haberse descrito altas cifras de éxito, un significativo porcentaje de pacientes sufren fracaso terapéutico. MétodosEstudio observacional retrospectivo de pacientes con sospecha de NT y sometidos a DMV con el objetivo de identificar los factores que determinaron la persistencia y recurrencia del dolor. ResultadosEn el presente estudio fueron incluidos 31 pacientes sometidos a 38 procedimientos de DMV por NT (7 pacientes fueron reintervenidos tras el fracaso de la primera operación). La edad media fue 58,5 años con predominio del sexo masculino (58,1%). El tiempo medio de evolución del dolor era 6,4 años afectando principalmente ramas V2 y V3 (46.7%). El conflicto neurovascular más frecuentemente descrito fue con la arteria cerebelosa superior (54.8%), y fue resuelto generalmente con teflón (75,9%).En nuestra serie de casos, la DMV obtuvo control del dolor en el 80.6% al año de la intervención, y el 61,3% al final periodo de seguimiento. Doce pacientes presentaron fracaso de la DMV: 5 casos de dolor persistente, y 7 casos de recurrencia del dolor. Un análisis detallado de estos fracasos determinó un diagnóstico erróneo como causa de dolor persistente en 4 pacientes, mientras que la interposición de materiales inadecuados para la resolución del conflicto neurovascular pudo ser el motivo de la recurrencia del dolor en otros 6 pacientes. ConclusiónEn nuestro estudio, los fracasos terapéuticos pudieron ser atribuidos a dos factores principalmente: diagnóstico erróneo y la interposición de un material inadecuado. Estos factores deben considerarse en la optimización del manejo de la DMV en paciente con NT." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusión" ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/25298496/unassign/S2529849624000650/v1_202410291637/en/main.assets" "Apartado" => null "PDF" => "https://static.elsevier.es/multimedia/25298496/unassign/S2529849624000650/v1_202410291637/en/main.pdf?idApp=UINPBA00004B&text.app=https://revistaneurocirugia.com/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2529849624000650?idApp=UINPBA00004B"]

Neurocirugía (English edition)

ISSN: 2529-8496

Neurocirugía is the official Journal of the Spanish Society of Neurosurgery (SENEC). It is published every 2 months (6 issues per year). Neurocirugía will consider for publication, original clinical and experimental scientific works associated with neurosurgery and other related neurological sciences.

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